Spine imaging after lumbar disc replacement: pitfalls and current recommendations

<p>Abstract</p> <p>Background</p> <p>Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures.</p> <p>Methods</p> <p>Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures.</p> <p>Results</p> <p>Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI.</p> <p>Conclusion</p> <p>Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.</p

Convergences and divergences of geographies from an East-Central European perspective

STUDY DESIGN:  Prospective cohort study. OBJECTIVE:  This study investigates the results of long posterior instrumentation with regard to complications and survival. SUMMARY OF BACKGROUND DATA:  Fractures of the cervical spine and the cervicothoracic junction related to ankylosing spinal disease (ASD) endanger both sagittal profile and spinal cord. Both anterior and posterior stabilization methods are well established, and clear treatment guidelines are missing. METHODS:  Forty-one consecutive patients with fractures of the cervicothoracic junction related to ASD were treated by posterior instrumentation. All patients were followed prospectively for 2 years using a standardized protocol. RESULTS:  Five patients experienced postoperative infections, 3 patients experienced postoperative pneumonia, 2 patients required postoperative tracheostomy, and 1 patient had postoperative cerebrospinal fluid leakage due to accidental durotomy. No patient required reoperation due to implant failure or nonunion. Mean survival was 52 months (95% confidence interval: 42-62 mo). Survival was affected by patient age, sex, smoking, and spinal cord injury. CONCLUSION:  Patients with ASD experiencing a fracture of the cervicothoracic region are at high risk of developing complications. The posterior instrumentation of cervical spinal fractures related to ASD is recommended due to biomechanical superiority. Level of Evidence: 4

Insertion torque is not a good predictor of pedicle screw loosening after spinal instrumentation: a prospective study in 8 patients

<p>Abstract</p> <p>Background</p> <p>Pedicle screw loosening is a major safety concern in instrumented spinal surgery due to loosening with potential pseudarthrosis and possible loss of correction requiring revision surgery. Several cadaver studies have compared insertion torque of pedicle screws with resistance to pullout or cyclic loading. In most of these studies, a correlation has been found between these variables. Clinical studies have been made, comparing insertion torque to bone mineral density or radiological signs of screw loosening. There are no clinical studies comparing insertion torque to extraction torque or other biomechanical parameters in vivo. This study was designed to investigate whether the insertion torque of pedicle screws can be used to predict the purchase of the screws.</p> <p>Methods</p> <p>The insertion torque of stainless steel pedicle screws was recorded in eight patients undergoing lumbar fusion surgery with four-screw constructs. Torque gauge manometers were used for the recordings. The implants were removed after one year, and the extraction torque of the screws was recorded.</p> <p>Results</p> <p>The mean insertion torque was 76 ± 41 Ncm and the mean extraction torque 29 ± 36 Ncm. The r value was 0.591, suggesting that there was a correlation between the insertion and extraction torque. However, the scattergram revealed that the screws could be divided into two groups, six screws with a high correlation between insertion and extraction torque, and 26 screws where no correlation could be demonstrated.</p> <p>Conclusions</p> <p>In this unique human in-vivo study, the insertion torque could not be used to predict the purchase of lumbar pedicle screws one year after implantation. It could be demonstrated that in vivo insertion torque alone is of minor value to estimate pullout strength, and should be combined with or replaced by more accurate measures.</p

Kyphoplasty in osteoporotic vertebral compression fractures - Guidelines and technical considerations

Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity

Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

BACKGROUND: Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial. PATIENTS AND METHODS: 150 patients (87 women) treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B) and 74 to ropivacain and oxycodone (group R). Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred. RESULTS: The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R). Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p &lt; 0.0001). Motor blockade was most frequent on day 1, occurring in 45% of the patients with no difference between the groups. Both regimes gave good pain control with average VAS under 40, but the pain relief was statistically better in group B. The number of pain breakthrough episodes did not differ between the groups. CONCLUSIONS: Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks

Разработка избирательного усилителя для приема сигналов поисковой системы

STUDY DESIGN: National registry cohort studyObjective. To investigate the effect of surgical stabilisation on survival of spinal fractures related to ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: Spinal fractures related to AS are associated with considerable morbidity and mortality. Multiple studies suggest a beneficial effect of surgical stabilisation in these patients. METHODS: In the Swedish patient registry all patients treated in an inpatient facility are registered with diagnosis and treatment codes. The Swedish mortality registry collects date and cause of death for all fatalities. Registry extracts of all patients with AS and spinal fractures including date of death and treatment were prepared and analysed for epidemiological purposes. RESULTS: 17297 individual patients with AS were admitted to treatment facilities in Sweden between 1987 and 2011. 990 patients with AS (age 66±14 years) had 1131 spinal fractures, of which 534 affected cervical, 352 thoracic, and 245 lumbar vertebrae. 13% had multiple levels of injuries during the observed period. Surgically treated patients had a greater survival than those treated non-surgically (HR = 0.79, p = 0.029). Spinal cord injury was the major factor contributing to mortality in this cohort (HR = 1.55, p&lt;0.001). The proportion of surgically treated spinal fractures increased linearly during the last decades (r = 0.92, p&lt;0.001) and was 64% throughout the observed years. CONCLUSIONS: Spinal cord injury threatened the survival of patients with spinal fractures related to AS. Even though surgical treatment is associated with a considerable complication rate, it improved the survival of spinal fractures related to AS

Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

<p>Abstract</p> <p>Background</p> <p>Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty.</p> <p>Patients and Methods</p> <p>We prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery.</p> <p>Results</p> <p>Preoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient.</p> <p>Conclusion</p> <p>The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.</p

Does climate change transform military medicine and defense medical support?

BackgroundClimate change has effects on multiple aspects of human life, such as access to food and water, expansion of endemic diseases as well as an increase of natural disasters and related diseases. The objective of this review is to summarize the current knowledge on climate change effects on military occupational health, military healthcare in a deployed setting, and defense medical logistics.MethodsOnline databases and registers were searched on August 22nd, 2022 and 348 papers retrieved, published between 2000 and 2022, from which we selected 8 publications that described climate effects on military health. Papers were clustered according to a modified theoretical framework for climate change effects on health, and relevant items from each paper were summarized.ResultsDuring the last decades a growing body of climate change related publications was identified, which report that climate change has a significant impact on human physiology, mental health, water- and vector borne infectious diseases, as well as air pollution. However, regarding the specific climate effects on military health the level of evidence is low. The effects on defense medical logistics include vulnerabilities in the cold supply chain, in medical devices functioning, in need for air conditioning, and in fresh water supply.ConclusionsClimate change may transform both the theoretical framework and practical implementations in military medicine and military healthcare systems. There are significant knowledge gaps on climate change effects on the health of military personnel in operations of both combat and non-combat nature, alerting the need for prevention and mitigation of climate-related health issues. Further research within the fields of disaster and military medicine is needed to explore this novel field. As climate effects on humans and the medical supply chain may degrade military capability, significant investments in military medical research and development are needed

Влияние Trichinella spiralis на структуру и иммуногистохимические показатели тканей экспериментальной глиомы и некоторых органов крыс

TRICHINELLA SPIRALISГЛИОМАГЛИАЛЬНЫХ КЛЕТОК ОПУХОЛИГЛИОМА ЗЛОКАЧЕСТВЕННАЯИММУНОГИСТОХИМИЯИММУННОГО ПОЗОЛОЧЕНИЯ И СЕРЕБРЕНИЯ МЕТОДИММУННОЙ МЕТКИ МЕТОДЫИММУНОГИСТОЦИТОХИМИЯKI-67 АНТИГЕНMIB-1 АНТИГЕНМОДЕЛИ НА ЖИВОТНЫХМОДЕЛИ НА ЛАБОРАТОРНЫХ ЖИВОТНЫХМОДЕЛИ НА ЭКСПЕРИМЕНТАЛЬНЫХ ЖИВОТНЫХКРЫСЫ ЛИНИИ WISTARКРЫСЫ ЛИНИИ ВИСТАРЦель – установить влияние инвазии Trichinella spiralis в дозе заражения 10 личинок на 1 г массы тела животного на иммуногистохимические показатели в тканях экспериментальной глиомы крыс в различные сроки наблюдения. В эксперименте использовали самок крыс линии Wistar. У животных первой серии эксперимента (1-4 группы) воспроизводили экспериментальную модель развития крысиной глиомы С6 in situ. Крыс второй серии эксперимента (5-8 группы) с моделированной крысиной глиомой заражали T. spiralis в дозе 10 личинок на 1 г массы тела животного. У животных всех групп на 14-е, 21-е, 28-е, 35-е сутки развития опухоли в опухолевом материале проводили макроскопическое, гистологическое и иммуногистохимическое исследования (определялась экспрессия GFAP – glial fibrillary acidic protein, S 100, вычислялся индекс пролиферативной активности Ki-67). Установлено, что инвазия T. spiralis в дозе 10 личинок на 1 г массы тела животного повышает экспрессию GFAP в биоптатах опухолевой ткани крысиной глиомы С6 in situ к 21-м и 28-м суткам после заражения в 3,08 и 3,8 раза соответственно; экспрессию S 100 к 7-м суткам развития инвазии в 3 раза, к 14-м – в 2,64 раза, к 21-м суткам после заражения – в 3,07 раза, к 28-м суткам – в 4,9 раза; индекс пролиферативной активности Ki 67 к 7-м суткам развития инвазии в 2,02 раза, к 14-м – в 1,69 раза, к 21-м суткам после заражения – в 3 раза, а к 28-м суткам – в 4,3 раза. Обнаружены метастатические очаги глиомы в легких крыс на 28 сутки развития трихинелл. В образцах ткани легких экспрессия GFAP к 28-м суткам оценивалась в 1+ (11%; 95% ДИ : 110,21Objectives. To determine the influence of Trichinella spiralis invasion in the dose of 10 larvae per 1 g of animal body weight on immunohistochemical parameters in the tissues of experimental glioma of rats in different periods of observation. Material and methods. Female rats of the Wistar line were used in the experiment. In animals of the first series of the experiment (groups 1-4) the experimental model of C6 rat glioma development in situ was simulated. Rats of the second series of the experiment (groups 5-8) with modelled rat glioma were infected with T. spiralis in the dose of 10 larvae per 1 g of animal body weight. In animals of all groups on the 14th, 21st, 28th, 35th days of tumor development in tumor material macroscopic, histological and immunohistochemical studies were performed (glial fibrillar acid protein (GFAP), S 100 expression were determined, Ki-67 proliferative activity index was calculated). Results. It has been found that the invasion of T. spiralis in the dose of 10 larvae per 1 g of animal body weight 3.08 and 3.8 times respectively increases GFAP expression in bioptates of tumor tissue of rat glioma C6 in situ by the 21st and the 28th days after infection; the expression of S 100 by the 7th day of invasion development – 3 times, by the 14th day of invasion – 2.64 times, by the 21st day after infection – 3.07 times, by the 28th day – 4.9 times; the index of proliferative activity Ki 67 by the 7th day of the invasion – 2.02 times, by the 14th day – 1.69 times, by the 21st day after infection – 3 times, and by the 28th day – 4.3 times. Metastatic foci of low-grade glioma have been revealed in the lungs of rats on the 28th day of Trichinella development. In lung tissue samples, GFAP expression by the 28th day was estimated to be 1+ (11%; 95% CI : 110.21-139.88; IRS=4). The expression of S 100 in the same samples was at the level of 1+ (15%; 95% CI : 123.27-132.12; IRS=4), and proliferative activity of the tumor (Ki-67) made up 40% (95% CI : 299.44-455.68). The expression of proteins S 100, GFAP, proliferative activity index Ki-67 in animals infected with T. spiralis was significantly higher than that in the groups with "pure" glioma in almost all periods of observation. On the 28th day after infection (35th the day of glioma growth) metastatic foci of glioma were found in the lungs